How To Use HCPCS Code G2163

HCPCS code G2163 describes the administration of an influenza vaccine to a patient between July 1 of the year prior to the measurement period and June 30 of the measurement period. This code is used to identify and bill for the specific service provided, and it is important for medical coders to understand its meaning and usage.

1. What is HCPCS G2163?

HCPCS code G2163 is a specific code used to identify the administration of an influenza vaccine within a specific time frame. It is important to note that this code is only applicable for influenza vaccines administered between July 1 of the year prior to the measurement period and June 30 of the measurement period.

2. Official Description

The official description of HCPCS code G2163 is “Patient received an influenza vaccine on or between July 1 of the year prior to the measurement period and June 30 of the measurement period.” The short description for this code is “Infl vacc 07/01 to 06/30.”

3. Procedure

1. Verify the eligibility of the patient for the influenza vaccine.
2. Prepare the necessary equipment and supplies for administering the vaccine.
3. Obtain informed consent from the patient or their legal guardian.
4. Administer the influenza vaccine to the patient following the appropriate medical guidelines and protocols.
5. Document the administration of the vaccine, including the date, time, dosage, and any relevant patient information.

4. When to use HCPCS code G2163

HCPCS code G2163 should be used when a healthcare provider administers an influenza vaccine to a patient between July 1 of the year prior to the measurement period and June 30 of the measurement period. It is important to ensure that the vaccine administration falls within this specific time frame in order to accurately use this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G2163, healthcare providers need to ensure that they have proper documentation to support the administration of the influenza vaccine. This includes documenting the date, time, dosage, and any relevant patient information. It is also important to follow the billing guidelines set forth by the payer, such as Medicare or other insurance companies, to ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G2163 was added to the Healthcare Common Procedure Coding System on January 1, 2020. It has an effective date of January 1, 2021. As of December 31, 2020, this code has been terminated. The termination of a code means that it is no longer valid for use in medical coding and billing.

7. Medicare and Insurance Coverage

HCPCS code G2163 falls under the coverage code C, which indicates that coverage is determined by carrier judgment. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B and may be bundled or not covered. It is important to check with Medicare or other insurance providers to determine the specific coverage and reimbursement policies for this code.

8. Examples

Here are five examples of when HCPCS code G2163 should be billed:

1. A patient visits their primary care physician on July 15, 2021, and receives an influenza vaccine. The physician should bill for the administration of the vaccine using HCPCS code G2163.
2. A patient visits a local pharmacy on June 25, 2020, and receives an influenza vaccine. The pharmacy should bill for the administration of the vaccine using HCPCS code G2163.
3. A patient visits an urgent care clinic on August 10, 2019, and receives an influenza vaccine. The clinic should not bill for the administration of the vaccine using HCPCS code G2163, as it falls outside of the specified time frame.
4. A patient visits a specialty clinic on May 5, 2022, and receives an influenza vaccine. The clinic should not bill for the administration of the vaccine using HCPCS code G2163, as it falls outside of the specified time frame.
5. A patient visits a mobile vaccination unit on December 20, 2020, and receives an influenza vaccine. The mobile vaccination unit should not bill for the administration of the vaccine using HCPCS code G2163, as the code was terminated on December 31, 2020.